Assessment of the effectiveness of surgical resections following tyrosine kinase inhibitor therapy in patients with EGFR-mutated stage III–IV lung adenocarcinoma

E. V. Levchenko; F. V. Moiseenko; S. V. Orlov; E. N. Imyanitov; A. E. Mikhnin; M. L. Gelfond; E. N. Slugin; S. M. Ergnyan; N. E. Levchenko; A. S. Zhabina; A. M. Ulitin; O. Yu. Mamontov; O. O. Lopushanskaya; E. V. Artemeva; A. I. Murtazin; V. I. Shabinskaya

doi:10.21294/1814-4861-2023-22-1-5-14

Assessment of the effectiveness of surgical resections following tyrosine kinase inhibitor therapy in patients with EGFR-mutated stage III–IV lung adenocarcinoma

https://doi.org/10.21294/1814-4861-2023-22-1-5-14

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Abstract

Objective. To assess the overall and disease-free survival rates in patients with EGFR-mutated lung adenocarcinoma, who underwent surgery after achieving the objective response to tyrosine kinase inhibitor (TKI) therapy.

Material and Methods. The overall and disease-free survival rates were analyzed in 18 patients with EGFR-positive lung adenocarcinoma, which was inoperable at presentation due to locally advanced disease or the evidence of distant metastasis. In accordance with the clinical standards, patients were recommended for TKI therapy. Surgical resection was performed after achieving the objective tumor response to TKI therapy. The control group included 23 patients with EGFR mutation-positive lung adenocarcinoma, who did not undergo surgery after receiving TKI therapy.

Results. The study revealed a statistically significant effect of surgical resection on the overall survival (OS) in patients with EGFR mutation-positive stage III–IV lung adenocarcinoma after response to TKI therapy (p=0.004). However, there was no statistically significant effect on the disease-free survival (DFS) (p=0.40). There was a tendency to increase in the median OS in patients of the study group (46 months) compared to that in patients of the control group (26 months). Surgery in the study group was characterized with some technical difficulties associated with severe fibrosis. However, this did not affect the duration of surgery and the volume of blood loss.

Conclusion. Tumor resection in patients with

EGFR mutation-positive stage III–IV lung adenocarcinoma is feasible and safe, but requires highly qualified team surgeons in well-equipped medical centers. Our study revealed that the combination of EGFR-TKI and tumor resection provided better PFS and OS than EGFR-TKI alone. However, further studies are required.

Keywords

lung cancer, lung adenocarcinoma, EGFR mutation, EGFR TKi, surgical treatment, complications

About the Authors

E. V. Levchenko

Evgeny V. Levchenko, MD, DSc, Corresponding Member of the Russian Academy of Sciences, Head of Surgical Thoracic Department, N.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of the Russia; Professor of the Department of Oncology, I.I. Mechnikov North-Western State Medical University of the Ministry of Health of the Russia

68, Leningradskaya St., 197758, St. Petersburg, Pesochny,

41, Kirochnaya St., 191015, St. Petersburg

Resercher ID (WOS): X-8697-2018,

Author ID (Scopus): 55658789500

F. V. Moiseenko

N.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of the Russia; Saint-Petersburg Clinical Scientific and Practical Center for Specialized Types of Medical Care (oncology); I.I. Mechnikov North-Western State Medical University of the Ministry of Health of the Russia
Russian Federation

Fyodor V. Moiseenko, MD, DSc, Associate Professor, Researcher, Scientific Department of Innovative Methods of Therapeutic Oncology and Rehabilitation, N.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of the Russia; Head of the Department of Chemotherapy, Saint-Petersburg Clinical Scientific and Practical Center for Specialized Types of Medical Care (oncology); Professor of the Department of Oncology, I.I. Mechnikov North-Western State Medical University of the Ministry of Health of the Russia

68, Leningradskaya St., 197758, St. Petersburg, Pesochny,

68a, Leningradskaya St., 197758, St. Petersburg, Pesochny,

41, Kirochnaya St., 191015, St. Petersburg

SPIN-код: 7462-2225,

Resercher ID (WOS): E-1775-2014

S. V. Orlov

I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Health of the Russia
Russian Federation

Sergey V. Orlov, MD, Professor, Corresponding Member of the Russian Academy of Sciences, Professor of the Department of Oncology of the Faculty of Postgraduate Education

6–8, Lev Tolstoy St., 197022, St. Petersburg, Pesochny

E. N. Imyanitov

N.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of the Russia; I.I. Mechnikov North-Western State Medical University of the Ministry of Health of the Russia; Saint-Petersburg State Pediatric Medical University of the Ministry of Health of the Russia
Russian Federation

Evgeny N. Imyanitov, MD, DSc, Corresponding Member of the Russian Academy of Sciences, Head of the Scientific Department of Tumor Growth Biology, N.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of the Russia (St. Petersburg, Russia); Professor of the Department of Oncology, I.I. Mechnikov North-Western State Medical University of the Ministry of Health of the Russia; Head of the Department of Medical Genetics, Saint-Petersburg State Pediatric Medical University of the Ministry of Health of the Russia

68, Leningradskaya St., 197758, St. Petersburg, Pesochny,

41, Kirochnaya St., 191015, St. Petersburg,

2, Litovskay St., 194100, St. Petersburg

Resercher ID (WOS): ABG-8619-2021,

Author ID (Scopus): 7003644486

A. E. Mikhnin

N.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of the Russia
Russian Federation

Alexander E. Mikhnin, MD, DSc, Leading Researcher, Scientific Department of Thoracic Oncology

68, Leningradskaya St., 197758, St. Petersburg, Pesochny

Author ID (Scopus): 6603214016

M. L. Gelfond

N.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of the Russia
Russian Federation

Mark L. Gelfond , MD, DSc, Senior Researcher, Scientific Department of Thoracic Oncology

68, Leningradskaya St., 197758, St. Petersburg, Pesochny

SPIN-код: 7120-8633

E. N. Slugin

N.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of the Russia
Russian Federation

Evgeny N. Slugin, MD, Oncologist, Clinical and Diagnostic Department, postgraduate student of the Scientific Department of Thoracic Oncology

68, Leningradskaya St., 197758, St. Petersburg, Pesochny

SPIN-код: 9114-3355,

Researcher ID (WOS): ABE-6637-2021,

Author ID (Scopus): 57193125197

S. M. Ergnyan

N.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of the Russia
Russian Federation

Stepan M. Ergnyan, MD, PhD, Oncologist, Surgical Thoracic Department, Senior Researcher of the Scientific Department of Thoracic Oncology

68, Leningradskaya St., 197758, St. Petersburg, Pesochny

SPIN-код: 2505-1777,

Author ID (Scopus): 55458244300

N. E. Levchenko

N.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of the Russia
Russian Federation

Nikita E. Levchenko, MD, PhD, Associate Professor, Department of Oncology, Oncologist, Surgical Thoracic Department

68, Leningradskaya St., 197758, St. Petersburg, Pesochny

SPIN-код: 6910-4776,

Author ID (Scopus): 55317892300

A. S. Zhabina

Albina S. Zhabina, MD, PhD, Researcher, Scientific Department of Innovative Methods of Therapeutic Oncology and Rehabilitation, N.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of the Russia; Department of Chemotherapy, Saint-Petersburg Clinical Scientific and Practical Center for Specialized Types of Medical Care (oncology) (St. Petersburg, Russia)

68, Leningradskaya St., 197758, St. Petersburg, Pesochny,

68a, Leningradskaya St., 197758, St. Petersburg, Pesochny

SPINкод: 1724-7764

A. M. Ulitin

I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Health of the Russia
Russian Federation

Andrey M. Ulitin, MD, Oncologist, Postgraduate of the Department of Oncology of the Faculty of Postgraduate Education

6–8, Lev Tolstoy St., 197022, St. Petersburg, Pesochny

O. Yu. Mamontov

N.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of the Russia
Russian Federation

Oleg Yu. Mamontov, MD, PhD, Oncologist, Surgical Thoracic Department

68, Leningradskaya St., 197758, St. Petersburg, Pesochny

SPIN-код: 1088-9224,

Resercher ID (WOS): ABE-5960-2021,

Author ID (Scopus): 55460892300

O. O. Lopushanskaya

N.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of the Russia
Russian Federation

Olga O. Lopushanskaya, MD, Oncologist, Surgical Thoracic Department

68, Leningradskaya St., 197758, St. Petersburg, Pesochny

SPIN-код: 6720-7764,

Researcher ID (WOS): ABE-5759-2021,

Author ID (Scopus): 57226888551

E. V. Artemeva

Saint-Petersburg Clinical Scientific and Practical Center for Specialized Types of Medical Care (oncology)
Russian Federation

Elizaveta V. Artemyeva, MD, Department of Chemotherapy

68a, Leningradskaya St., 197758, St. Petersburg, Pesochny

A. I. Murtazin

N.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of the Russia
Russian Federation

Azat I. Murtazin, Postgraduate, Scientific Department of Tumor Growth Biology

68, Leningradskaya St., 197758, St. Petersburg, Pesochny

SPIN-код: 5673-4976,

Researcher ID (WOS): L-1699-2015,

Author ID (Scopus): 57223826611

V. I. Shabinskaya

N.N. Petrov National Medical Research Center of Oncology of the Ministry of Health of the Russia
Russian Federation

Victoria I. Shabinskaya, Methodologist, Accreditation and Simulation Center

68, Leningradskaya St., 197758, St. Petersburg, Pesochny

SPIN-код: 7107-7458,

Researcher ID (WOS): ABE-5952-2021,

Author ID (Scopus): 57223818916

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Levchenko E.V., Moiseenko F.V., Orlov S.V., Imyanitov E.N., Mikhnin A.E., Gelfond M.L., Slugin E.N., Ergnyan S.M., Levchenko N.E., Zhabina A.S., Ulitin A.M., Mamontov O.Yu., Lopushanskaya O.O., Artemeva E.V., Murtazin A.I., Shabinskaya V.I. Assessment of the effectiveness of surgical resections following tyrosine kinase inhibitor therapy in patients with EGFR-mutated stage III–IV lung adenocarcinoma. Siberian journal of oncology. 2023;22(1):5-14. (In Russ.) https://doi.org/10.21294/1814-4861-2023-22-1-5-14

This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1814-4861 (Print)
ISSN 2312-3168 (Online)

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Siberian journal of oncology

Assessment of the effectiveness of surgical resections following tyrosine kinase inhibitor therapy in patients with EGFR-mutated stage III–IV lung adenocarcinoma

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